Vascular Surgery — MCQs

Vascular Surgery Indian Medical PG Practice Questions and MCQs

Question 61: Sclerotherapy is contraindicated in all of the following conditions EXCEPT:

A. Deep vein thrombosis
B. Saphenofemoral incompetence
C. Recurrent varices (Correct Answer)
D. Huge varicosities

Explanation: **Explanation:** Sclerotherapy involves the injection of a sclerosant (e.g., Sodium Tetradecyl Sulfate) into a vein to induce endothelial damage, fibrosis, and eventual obliteration of the lumen. **Why Recurrent Varices is the Correct Answer:** Sclerotherapy is a primary indication for **recurrent varices** and small residual veins following surgery (Trendelenburg procedure or stripping). In recurrent cases, the anatomy is often distorted by previous scarring, making repeat surgery technically difficult and risky. Sclerotherapy provides a minimally invasive and effective alternative to target these specific vessels. **Analysis of Contraindications (Incorrect Options):** * **A. Deep Vein Thrombosis (DVT):** This is an **absolute contraindication**. In DVT, the superficial venous system acts as a critical collateral pathway for venous return. Obliterating superficial veins in the presence of an occluded deep system can lead to severe venous congestion and phlegmasia. * **B. Saphenofemoral Incompetence (SFI):** Sclerotherapy is generally ineffective for significant SFI because the high pressure from the deep system will cause rapid recurrence. These cases require surgical ligation (Trendelenburg procedure) or endovenous thermal ablation to address the source of reflux first. * **C. Huge Varicosities:** Large, dilated veins are a relative contraindication. They have a high risk of failure, skin staining (hemosiderin deposits), and a higher incidence of superficial thrombophlebitis post-procedure. **High-Yield Clinical Pearls for NEET-PG:** * **Indications:** Reticular veins (<3mm), telangiectasias (spider veins), and recurrent varices. * **Complications:** Skin necrosis (if extravasated), hyperpigmentation, and rarely, anaphylaxis or visual disturbances (scotomas). * **Fegan’s Technique:** A classic method of sclerotherapy where the injection is performed into an empty vein while the limb is elevated. * **Foam Sclerotherapy (Tessari Technique):** Uses a mix of air and sclerosant to increase the surface area of contact, allowing for the treatment of slightly larger veins compared to liquid sclerotherapy.

Question 62: Management of subclavian artery injury due to inadvertent central catheter insertion include all of the following except?

A. Closure device
B. Mechanical Compression (Correct Answer)
C. Covering stent
D. Tract embolization

Explanation: **Explanation:** The management of inadvertent subclavian artery cannulation (the "Hoarseness of the Subclavian" or "Big Bore" injury) has shifted away from traditional methods due to the anatomical constraints of the vessel. **Why Mechanical Compression is the Correct Answer (The "Except"):** Unlike the femoral or radial arteries, the **subclavian artery is a non-compressible vessel**. It lies posterior to the clavicle and subclavius muscle, making external manual compression ineffective for achieving hemostasis. Attempting compression often leads to delayed recognition of internal bleeding, resulting in massive hemothorax, tension hemothorax, or compressive mediastinal hematomas. Therefore, "pull and press" is contraindicated for large-bore injuries in this location. **Analysis of Other Options:** * **Closure Devices (A):** Percutaneous suture-mediated or collagen-plug closure devices (e.g., ProGlide) are increasingly used to seal the arteriotomy site upon catheter removal. * **Covering Stent (C):** Endovascular management using a covered stent (stent-graft) is a preferred minimally invasive approach to exclude the injury site while maintaining distal flow. * **Tract Embolization (D):** This involves using prothrombotic agents or coils to seal the tract as the catheter is withdrawn, preventing track-related bleeding. **Clinical Pearls for NEET-PG:** * **Zone of Injury:** Subclavian injuries are difficult to manage surgically because they often require clavicular resection or thoracotomy for proximal control. * **The "Rule of Thumb":** If a large-bore catheter (≥7 French) is inadvertently placed in a non-compressible artery, **do not remove it** until a definitive repair plan (Endovascular or Surgical) is in place. * **Gold Standard:** Endovascular repair is now preferred over open surgery for stable patients due to lower morbidity.

Question 63: Elgiloy is used in the preparation of which of the following?

A. Vascular stent (Correct Answer)
B. Mesh
C. Bone plates
D. All of the above

Explanation: **Explanation:** **Elgiloy** is a specialized non-magnetic cobalt-chromium-nickel alloy originally developed for the watchmaking industry but now widely used in medical therapeutics. **Why Vascular Stents is the Correct Answer:** The primary reason Elgiloy is used in **vascular stents** is its exceptional mechanical properties: high fatigue resistance, high strength, and excellent biocompatibility. Most importantly, it possesses **"shape memory"** characteristics and high elasticity, making it ideal for self-expanding stents. These stents can be compressed for catheter delivery and then reliably expand to maintain vessel patency in peripheral vascular interventions (e.g., iliac or femoral arteries). **Analysis of Incorrect Options:** * **B. Mesh:** Surgical meshes (used for hernia repairs) are typically made of synthetic polymers like Polypropylene, Polyester, or PTFE. Metal meshes are rare and usually made of Titanium or Stainless Steel. * **C. Bone Plates:** Orthopedic implants like bone plates and screws are traditionally made of Stainless Steel (316L) or Titanium alloys. While cobalt-chrome alloys are used in joint replacements (prostheses), Elgiloy specifically refers to the thin, spring-tempered wire/strip form used in stents and dental wires. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Elgiloy consists of Cobalt (40%), Chromium (20%), Nickel (15%), and Molybdenum (7%). * **Nitinol vs. Elgiloy:** While Nitinol (Nickel-Titanium) is the most common shape-memory alloy, Elgiloy is a significant alternative in vascular surgery and orthodontics. * **MRI Safety:** Elgiloy is non-ferromagnetic, making stents made from this material generally **MRI-compatible**. * **Other uses:** It is also frequently used in **orthodontic archwires** and heart valve components due to its corrosion resistance.

Question 64: What is the most common cause of superficial thrombophlebitis?

A. Intravenous catheters/infusion (Correct Answer)
B. Deep vein thrombosis (DVT)
C. Varicose veins
D. Trauma

Explanation: **Explanation:** Superficial thrombophlebitis (STP) is the inflammation of a superficial vein associated with a blood clot. **1. Why Option A is Correct:** In modern clinical practice, **intravenous (IV) catheterization and infusions** are the most common causes of superficial thrombophlebitis. This occurs due to mechanical irritation of the vein wall by the cannula or chemical irritation from the infused medications/fluids (iatrogenic trauma). It most frequently affects the cephalic or basilic veins of the upper limbs. **2. Analysis of Incorrect Options:** * **Option B (DVT):** While STP and DVT share similar risk factors (Virchow’s triad), DVT is a complication or a concurrent finding rather than the primary *cause* of STP. * **Option C (Varicose Veins):** This is the most common **spontaneous** cause of STP in the lower limbs. However, globally and across all hospital settings, IV-induced phlebitis remains more frequent. * **Option D (Trauma):** While physical trauma can lead to vein injury and thrombosis, it is less frequent than the controlled "micro-trauma" caused by millions of IV cannulations performed daily. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mondor’s Disease:** A specific type of superficial thrombophlebitis involving the lateral thoracic or epigastric veins; it presents as a "cord-like" structure on the chest wall. * **Trousseau’s Sign (Migratory Thrombophlebitis):** Recurrent STP at different sites, strongly associated with internal malignancies, most commonly **Carcinoma of the Pancreas**. * **Management:** Most cases are self-limiting. Treatment includes NSAIDs, warm compresses, and elevation. If STP occurs at the saphenofemoral junction, anticoagulation is required to prevent progression to DVT.

Question 65: The Brodie-Trendelenburg test is performed to assess for which condition?

A. Sapheno-femoral incompetence (Correct Answer)
B. Deep vein thrombosis
C. Varicose veins
D. Superficial migratory thrombophlebitis

Explanation: ### Explanation The **Brodie-Trendelenburg test** is a clinical bedside examination used to differentiate between valvular incompetence at the saphenofemoral junction (SFJ) and incompetence of the perforator veins. **1. Why Option A is Correct:** The test is performed by elevating the patient's leg to empty the superficial veins, applying a tourniquet just below the SFJ, and asking the patient to stand. * **Trendelenburg I (Positive):** If the veins remain empty while the tourniquet is on but fill rapidly from above once the tourniquet is **released**, it confirms **Sapheno-femoral incompetence**. * **Trendelenburg II (Negative):** If the veins fill rapidly from below even **while the tourniquet is still on**, it indicates **perforator incompetence**. **2. Why Other Options are Incorrect:** * **B. Deep Vein Thrombosis (DVT):** DVT is assessed using the **Homan’s sign** (calf pain on dorsiflexion) or **Moses sign**, though Gold Standard diagnosis is via Doppler Ultrasound. * **C. Varicose Veins:** While the test is performed *on* patients with varicose veins, it is specifically designed to identify the *anatomical site of reflux* (the SFJ), not just to diagnose the presence of the veins themselves. * **D. Superficial Migratory Thrombophlebitis:** This is a clinical diagnosis (Trousseau’s sign) often associated with visceral malignancies (e.g., pancreatic cancer); it does not involve valvular assessment. **3. High-Yield Clinical Pearls for NEET-PG:** * **Perthes Test:** Used to assess the patency of the **Deep Venous System**. If a patient develops pain while walking with a tourniquet applied, it suggests deep vein occlusion. * **Schwartz Test:** A tap test used to demonstrate a continuous column of blood in a varicose vein. * **Fegan’s Method:** Used to identify the exact site of incompetent perforators by palpating "blow-outs" or gaps in the fascia. * **Gold Standard Investigation:** Venous Duplex Ultrasound is now the investigation of choice for varicose veins, replacing these clinical tests in modern practice.

Question 66: A 57-year-old female presented with shoe-claudication. Peripheral aneurysm was suspected. Which of the following is the most common site of peripheral aneurysm?

A. Femoral artery
B. Radial artery
C. Popliteal artery (Correct Answer)
D. Brachial artery

Explanation: **Explanation:** The **popliteal artery** is the most common site for peripheral arterial aneurysms, accounting for approximately **70–80%** of all peripheral cases. These aneurysms are frequently associated with abdominal aortic aneurysms (AAA); about 50% of patients with a popliteal aneurysm will have a synchronous AAA. Furthermore, they are often bilateral (50–70% of cases). The clinical presentation often involves "shoe-claudication" or distal ischemia due to thrombosis or embolism, rather than rupture. **Analysis of Options:** * **Popliteal Artery (Correct):** As the most frequent site, it is a high-yield fact for surgical exams. It is defined as a dilation >1.5 times the normal diameter. * **Femoral Artery (Incorrect):** This is the second most common site for peripheral aneurysms (specifically the common femoral artery). While significant, it occurs less frequently than popliteal aneurysms. * **Radial and Brachial Arteries (Incorrect):** Aneurysms in the upper extremities are rare. When they occur, they are often "pseudoaneurysms" resulting from trauma or iatrogenic injury (e.g., arterial lines or catheterization) rather than true atherosclerotic aneurysms. **NEET-PG High-Yield Pearls:** * **Rule of 50s:** 50% of popliteal aneurysms are bilateral; 50% are associated with an AAA. * **Most common complication:** Thromboembolism leading to "Blue Toe Syndrome" or acute limb ischemia (Rupture is rare, unlike AAA). * **Diagnosis:** Duplex Ultrasonography is the initial investigation of choice. * **Indication for Surgery:** Symptomatic patients or asymptomatic aneurysms >2 cm in diameter.

Question 67: Which of the following statements is true about mesenteric vein thrombosis?

A. Peritoneal signs are always present. (Correct Answer)
B. Thrombectomy is always performed.
C. Heparin is administered.
D. Surgery may result in short bowel syndrome.

Explanation: **Explanation:** Mesenteric Vein Thrombosis (MVT) is a form of mesenteric ischemia that often presents more insidiously than arterial occlusion. **1. Why Option A is Correct:** In the context of this specific question (often sourced from classic surgical texts), the presence of **peritoneal signs** (rebound tenderness, guarding, rigidity) is the hallmark indicator of **intestinal infarction**. Once the venous congestion leads to transmural necrosis, peritonitis becomes inevitable. While early MVT may present with "pain out of proportion to physical findings," the progression to infarction is characterized by the definitive development of peritoneal signs, necessitating urgent surgical intervention. **2. Why the other options are incorrect:** * **Option B:** Thrombectomy is **not** always performed. It is technically difficult in the venous system and is usually reserved for specific cases of acute, large-vessel involvement. The mainstay of surgical treatment is the resection of necrotic bowel. * **Option C:** While Heparin is the primary medical treatment for MVT to prevent clot propagation, it is **contraindicated** if the patient has active gastrointestinal bleeding or if surgery is imminent. Therefore, it is not "always" administered without clinical discretion. * **Option D:** While surgery *can* lead to short bowel syndrome if massive resection is required, it is a **complication**, not a definitive rule or a characteristic feature of the disease process itself. **Clinical Pearls for NEET-PG:** * **Risk Factors:** Look for Virchow’s triad—hypercoagulable states (Protein C/S deficiency, Factor V Leiden), portal hypertension, or intra-abdominal inflammation (pancreatitis). * **Diagnosis:** Contrast-enhanced CT is the gold standard (shows the "target sign" or a filling defect in the SMV). * **Management:** If no peritonitis, treat with anticoagulation. If peritonitis is present, perform laparotomy and resection of non-viable segments. * **Key Difference:** MVT has a better prognosis than Mesenteric Arterial Embolism (MAE).

Question 68: Most commonly, varicose veins are seen with which of the following?

A. Long saphenous vein (Correct Answer)
B. Short saphenous vein
C. Both
D. Popliteal and femoral vein

Explanation: **Explanation:** Varicose veins are dilated, tortuous, and elongated superficial veins caused by valvular incompetence and increased venous pressure. **Why Option A is Correct:** The **Long Saphenous Vein (LSV)**, also known as the Great Saphenous Vein, is the most common site for primary varicose veins. This is due to its significant length (the longest vein in the body) and the high hydrostatic pressure it must withstand while draining the medial aspect of the leg and thigh. The most frequent site of valvular failure is the **saphenofemoral junction (SFJ)**, where the LSV joins the common femoral vein. **Why Other Options are Incorrect:** * **Option B:** While the Short Saphenous Vein (SSV) can become varicose (often due to saphenopopliteal junction incompetence), it is statistically less common than LSV involvement. * **Option C:** Although both can be involved simultaneously, the question asks for the "most common" single site, which remains the LSV. * **Option D:** Popliteal and femoral veins are **deep veins**. Varicose veins, by definition, involve the superficial venous system. Incompetence in deep veins leads to Chronic Venous Insufficiency (CVI) or DVT, not primary varicosities. **Clinical Pearls for NEET-PG:** * **Trendelenburg Test:** Used to differentiate between saphenofemoral incompetence and perforator incompetence. * **Gold Standard Investigation:** Duplex Ultrasound (Doppler) is the investigation of choice to map the anatomy and identify reflux. * **Treatment of Choice:** Endovenous Thermal Ablation (Laser/Radiofrequency) has largely replaced traditional "Stripping and Ligation." * **Brodie-Trendelenburg Test:** Specifically identifies the level of valvular incompetence.

Question 69: What is the most common cause of pulmonary embolism?

A. Thrombosis of prostatic veins
B. Thrombosis of leg veins (Correct Answer)
C. Inferior vena cava thrombosis
D. None of the above

Explanation: **Explanation:** Pulmonary Embolism (PE) is a life-threatening condition caused by the obstruction of the pulmonary arterial system by a detached thrombus. The most common source of these emboli is **Deep Vein Thrombosis (DVT) of the leg veins**, accounting for over 90% of cases. **Why Option B is Correct:** The deep veins of the lower limbs (specifically the popliteal, femoral, and iliac veins) are the primary sites for thrombus formation due to Virchow’s Triad (stasis, endothelial injury, and hypercoagulability). Thrombi formed in these large-caliber vessels are more likely to propagate, detach, and travel through the right heart into the pulmonary circulation. **Why Other Options are Incorrect:** * **Option A (Prostatic veins):** While pelvic vein thrombosis (including prostatic and uterine veins) can cause PE, especially after pelvic surgeries, it is significantly less common than lower limb DVT. * **Option C (IVC thrombosis):** Thrombosis of the Inferior Vena Cava is usually a result of the upward extension of a clot from the iliofemoral veins. Primary IVC thrombosis is rare and not the leading cause of PE. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for DVT:** The calf veins (soleal sinuses); however, **proximal DVT** (above the knee) carries a much higher risk of causing PE. * **Gold Standard Investigation:** CT Pulmonary Angiography (CTPA) is the investigation of choice for PE. * **ECG Finding:** The most common finding is sinus tachycardia; the "classic" S1Q3T3 pattern is specific but seen in fewer than 20% of patients. * **Treatment:** Immediate anticoagulation with Heparin (LMWH or Unfractionated) followed by oral anticoagulants.

Question 70: What is the gold standard investigation of choice for deep vein thrombosis?

A. Double contrast duplex
B. Venography (Correct Answer)
C. CT scan
D. MRI

Explanation: **Explanation:** The **gold standard** investigation for Deep Vein Thrombus (DVT) is **Ascending Contrast Venography**. This procedure involves injecting a radiopaque contrast medium into a dorsal foot vein and using fluoroscopy to visualize the deep venous system. A diagnosis of DVT is confirmed by the presence of a persistent **intraluminal filling defect** seen in at least two different projections. **Analysis of Options:** * **Venography (Correct):** While it is the definitive "gold standard" due to its high accuracy, it is rarely performed in modern clinical practice because it is invasive, painful, and carries risks like contrast-induced nephropathy or even iatrogenic venous thrombosis. * **Duplex Ultrasound (Incorrect):** This is the **investigation of choice (IOC)** and the first-line screening tool in clinical practice. It has high sensitivity and specificity for proximal DVT but is not considered the "gold standard" because it is operator-dependent and less accurate for calf vein or pelvic thrombi. * **CT/MRI (Incorrect):** CT Venography and MRV are highly accurate and useful for evaluating DVT in the pelvic veins or Vena Cava (where ultrasound is limited), but they are not the established gold standard. **Clinical Pearls for NEET-PG:** * **Investigation of Choice (IOC):** Color Duplex Ultrasound (Non-invasive). * **Gold Standard:** Contrast Venography (Invasive). * **Most sensitive blood test:** D-Dimer (High negative predictive value; used to rule out DVT in low-risk patients). * **Wells Criteria:** Used for clinical probability scoring of DVT. * **Phlegmasia Cerulea Dolens:** A limb-threatening emergency characterized by massive iliofemoral DVT causing total venous occlusion and cyanosis.

Practice by Chapter

Atherosclerotic Disease

Practice Questions

Aortic Aneurysms

Practice Questions

Peripheral Arterial Disease

Practice Questions

Carotid Artery Disease

Practice Questions

Venous Thromboembolism

Practice Questions

Chronic Venous Insufficiency

Practice Questions

Mesenteric Vascular Disease

Practice Questions

Vascular Trauma

Practice Questions

Vascular Access for Hemodialysis

Practice Questions

Endovascular Techniques

Practice Questions

Diabetic Foot Vascular Disease

Practice Questions

Vasculitis

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free